There are approximately 1 million sharps and/or needlestick related injuries reported in the United States annually. This equates to about two needlestick injuries every minute. However, it is also reported that about 50% of the injuries that occur go unreported. Taking the unreported injuries into consideration, there could be upwards of 2 million sharps and/or needlestick injuries per year in this country.
Sharps related injuries carry the potential of infecting the injured person with a host of diseases which include, for example, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). According to a 1997 report from the Centers for Disease Control and Prevention, the risk of HIV seroconversion, after a needlestick or cut exposure to HIV-infected blood is 0.3%. This risk increases with: 1) an increase in the quantity of infected blood being introduced into the injured tissue, 2) a higher viral load in the source of the contaminated blood at the time of the exposure, 3) an increased depth of the wound, and 4) if no post exposure treatment was administered.
Hollow bore needles, for example, increase the risk of contracting a disease, due to a sharps and/or needlestick related injury, because such needles can both deliver relatively large amounts of infected blood and achieve a fairly deep percutaneous penetration. It is to be appreciated that patients who are in the laterstages of AIDS usually have a high HIV load in their blood. They also require significant medical treatment including vascular access via hollow bore needles. Some of these patients get dementia and become relatively uncooperative during the later stages of AIDS prior to death. This condition can further increase the potential risk of an inadvertent needlestick injury to a healthcare worker.
As of December 1996, the Centers for Disease Control and Prevention had reported 52 documented cases and 111 possible cases of occupationally acquired HIV among healthcare workers in this country. A majority of these cases, i.e. 87%, are directly related to a sharps injury.
While HIV is a serious concern, hepatitis has a higher transmission rate and can be just as deadly. Although HBV carries a risk of infection of about 30%, which is one hundred times greater than HIV, healthcare workers can and should get vaccinated against this disease. HCV is a different story because of the lack of an available vaccine. HCV carries a about 10% risk of infection. Almost everyone contracting HCV will become a chronic carrier and about two-thirds will go on to have elevated liver enzymes requiring expensive drug treatment. HCV is currently the leading cause for liver transplant which costs upward of $500,000.
Currently on the market, there are numerous devices that shield, contain, and/or facilitate removal of a needle to minimize the risk of a healthcare worker getting stuck, and possibly infected, by a contaminated sharps needle. Such prior art devices, however, have only penetrated about 15% of the total United States market. The reason for this is several fold: such devices increase the cost of using the needle, some devices may be somewhat more difficult to utilize, and healthcare worker indifference to the seriousness of the potential problem. The bottom line is that needlesticks are occurring at a rate of about 2 to 4 per minute each day.
State legislation, starting with the state of California, is putting teeth into current OSHA regulations. These new regulations are requiring the use of sharps protection devices. The use of such devices has been shown to reduce the incidence of injury by up to 85%. But such efforts have not completely eliminated all of the sharps injuries.
The current procedure for post needlestick injury is to immediately administer first aid. This is generally defined as expressing blood from the site of the sharps injury in an attempt to flush the wound with one's own blood as completely as possible. If the expressing procedure is successfully executed, this can substantially reduce the viral loading at the site and hence substantially reduce the chance of infection resulting from the needle stick. Following the expressing step, it is next suggested to wash the injured area with an antimicrobial soap. There are some data that indicate vigorously scrubbing of injured area with an antimicrobial/antiviral agent(s) is beneficial. Next, the healthcare employee needs to report the incident to the appropriate authorities and be examined by a physician. Finally, once all of the above steps are completed and a full medical assessment is made, a treatment program can then be developed for the injured individual. It is to be appreciated that the resulting treatment program possibly involves a multi-drug regiment to reduce the risk of infection.
It is to be appreciated that the fact that a needlestick injury has occurred is very stressful to the injured individual. As a result of this, self-administering first aid by the individual stuck with the needle, during this stressful time, may possibly not be properly or completely administered. Anything, procedure or system, that can minimize or eliminate the guess work out of the initial first aid treatment because of a needlestick injury can insure more consistent and effective handling of such sharps injuries.